Preface

Lillias Maguire, MD

That diverticulitis presents a challenge to the clinician is obvious in the upending of treatment paradigms throughout the past two decades. Avoidance of nuts and seeds, use of antibiotics, routine colectomy for uncomplicated episodes, and mandatory operations for complicated presentations have all been called into serious question. Furthermore, despite the commonality, increasing incidence, and morbidity of the disease, the pathophysiology remains incompletely understood. Surgeons still struggle to answer patients' fundamental questions: “why did I get this disease?”; “what does the future hold for me?”; “what should I do to manage it best?”. Rather than getting to the heart of these basic questions, surgical thinking is all too often focused on “should I make an anastomosis?” and “can I do this minimally invasively?”. While these questions are clinically relevant, they are unlikely to really improve our understanding or generate a new treatment paradigm for diverticulitis.

In this edition, the authors tackle a variety of topics in diverticular disease with extensive research and thoughtful commentary. Many of the articles shed light on etiopathogenesis by providing up-to-date information on epidemiology, diet, genetics, microbiota, and structural changes observed in diverticulitis. Others consider unusual presentations and contexts of diverticular disease, and finally, some ask us to consider how we make decisions through risk prediction, considered decision-making, and improved understanding of patient preferences.

These articles are excellent and comprehensive, but the reader will note that each one reflects the huge amount still to be discovered across the spectrum of diverticulitis. By reflecting the current state of research perfectly, the articles generate more questions than they answer, and because of that, it is an exciting time to be a diverticulitis researcher. By shedding light through basic research on the triggers that lead from normal colon to diverticulosis or from diverticulosis to diverticulitis, we can inform risk stratification, patient counseling, and clinical decision-making and potentially generate new therapeutic tools for this common disease.

Publication History

Article published online:
08 October 2024